Some chest problems cannot be cured — but the symptoms they cause can almost always be eased. Breathlessness from fluid around the lung or a narrowed airway, pain from the ribs or chest wall, a persistent cough or coughing up blood, and the breathlessness of advanced emphysema can all be relieved by well-chosen, often minor, procedures. Mr Lawrence Okiror is a Consultant Thoracic and Robotic Surgeon who leads the interventional airway service at Guy’s and St Thomas’ and offers symptom-directed thoracic care privately at London Bridge Hospital and The Lister Hospital Chelsea — for patients in whom the aim is comfort and function rather than cure. He works alongside oncology, respiratory, palliative care and home-care teams. Seen within 2–3 working days. Self-referrals welcome.
Last reviewed: June 2026 · Mr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
Fluid drainage and indwelling catheters, airway stenting and debulking, and diaphragm surgery — often under local anaesthetic and suitable for frail or palliative patients.
Mr Okiror leads the interventional bronchoscopy and airway service at Guy’s and St Thomas’, offering rigid as well as flexible bronchoscopy for obstruction, bleeding and stenting.
Symptom control includes the judgement that no procedure is needed — most rib fractures, for example, are managed without surgery.
Thoracic surgery is usually discussed in terms of cure — removing a cancer, clearing an infection. But in advanced or inoperable disease, a well-chosen procedure is among the most effective tools for relieving a symptom. Draining a malignant pleural effusion can ease breathlessness within a day; reopening an obstructed airway can restore a voice, a swallow and a night’s sleep. The goal is comfort and function, and it is a legitimate goal in its own right.
The same judgement runs in the other direction. Knowing when not to intervene is part of the same skill — most rib fractures heal without an operation, and a procedure that will not change how a patient feels is not worth doing. Mr Okiror reviews each situation personally and gives an honest view of what intervention can and cannot achieve, working with the teams already caring for the patient.
A short orientation to each, with a link to fuller information. Whether a procedure will help — and whether it is worth doing — is decided after assessment, not from a web page.
Fluid collecting around the lung is a common cause of breathlessness in advanced disease. It can be drained, and its return prevented, with an indwelling catheter managed at home or a procedure to seal the space. Read more →
A narrowed or obstructed airwayA tumour or scarring narrowing the windpipe or a main airway causes breathlessness, cough, infection or bleeding. Rigid and flexible bronchoscopy allow it to be reopened, stented or debulked — often with immediate relief. Read more →
Coughing up blood (haemoptysis)Coughing up blood needs prompt assessment to find the cause and, where it comes from the airway, can often be controlled at bronchoscopy. Read more →
Breathlessness in advanced emphysemaFor selected patients with severe emphysema, endobronchial valve therapy or lung volume reduction surgery improves breathlessness and function. A functional treatment for emphysema, not palliative care — included here because breathlessness is the shared symptom. Read more →
Breathlessness from a raised or paralysed diaphragmWhen a weak or paralysed diaphragm is the cause of breathlessness, surgery to tighten it (plication) can restore lung capacity and ease symptoms. Read more →
Chest wall and rib painMost rib fractures are managed without surgery — pain control, breathing exercises and time. Fixation is reserved for an unstable chest wall or uncontrolled pain. Read more →
Targeted pain controlRegional pain control — rather than reliance on strong painkillers — keeps patients breathing well and mobile. Read more →
Long-standing chest infection (empyema)Chronic infection in the chest can be controlled with drainage or limited surgery, including in patients not fit for a major operation. Read more →
Symptom-directed thoracic care is almost always shared care. It sits alongside the treatment a patient is already having, and is coordinated with the team in charge.
A referrer can ask about one specific problem — a recurrent effusion, an obstructing airway lesion — without transferring the patient’s wider care. Mr Okiror advises on, or carries out, the intervention and reports back.
For patients under oncology, respiratory or palliative care, symptom-directed intervention adds comfort and function alongside their existing treatment, coordinated with the team in charge.
For home-care providers and families, several procedures — an indwelling pleural catheter in particular — are designed to keep a patient comfortable at home and out of hospital. Drainage can be carried out by a district nurse or a trained carer.
Whether a procedure will help — and whether it is worth doing — is decided after a proper assessment and an honest conversation about the goal of care.
A second opinion on whether a symptom can be eased is welcome — for patients told that breathlessness or pain cannot be helped, and for clinicians wanting an independent view on whether a procedure is worthwhile. It is often the right step when there is more than one reasonable option and a patient or family wants to understand them before deciding.
Mr Okiror reviews the imaging and history personally and gives a clear, honest view of what is and is not possible. A second opinion clarifies the options; it does not promise a different answer, and where nothing further is sensible, he will say so plainly. Referrals from other clinicians for an independent view are equally welcome.
Relieving a chest symptom well depends on having the full range of options and the judgement to choose between them. Mr Okiror leads the interventional bronchoscopy and airway service at Guy’s and St Thomas’, and offers rigid as well as flexible bronchoscopy — the rigid technique is what allows an obstructed airway to be debulked, stented or treated with laser, rather than only inspected. He is the sole operator for endobronchial valve therapy and lung volume reduction surgery at Guy’s and St Thomas’ and at London Bridge Hospital, and works across the full range of pleural, airway and chest-wall problems.
That breadth is the point. One surgeon who can drain an effusion, open an airway, control chest-wall pain and recognise when an operation will not help can match the intervention to the symptom — and say plainly when the right answer is to do nothing. Care is coordinated with the oncology, respiratory, palliative care and home-care teams already involved, rather than delivered in isolation.
Plain answers to the questions referrers, care teams and patients ask most. To discuss a patient or arrange an assessment, an appointment can usually be arranged within 2–3 working days.
Or call Jo Mitchelson, PA:
020 7952 2882
Private appointments within 2–3 working days at London Bridge Hospital and The Lister Hospital Chelsea. Mr Okiror reviews the imaging personally and gives a clear, honest view of what intervention can achieve. He works alongside oncology, respiratory, palliative care and home-care teams. Self-referrals welcome.
Jo Mitchelson, PA · 020 7952 2882 · pa@lungsurgeon.co.uk
St Thomas’ Hospital #1 UK · Guy’s Hospital #2 UK · London Bridge Hospital #10 UK · Newsweek World’s Best Hospitals 2026
Disclosures
This page is general information for patients, families and referring clinicians, not medical advice for any individual. Mr Lawrence Okiror is a Consultant Thoracic and Robotic Surgeon at Guy’s and St Thomas’ NHS Foundation Trust, with private practising privileges at London Bridge Hospital and The Lister Hospital Chelsea, where he leads the interventional bronchoscopy and airway service at the Trust. Symptom-directed thoracic care is delivered alongside the oncology, respiratory, palliative care and other teams already involved. He has no commercial relationships relevant to this content. Endobronchial valve therapy is described as a functional treatment for emphysema, not as palliative care. Decisions about whether a procedure is appropriate should be made on a case-by-case basis after appropriate clinical assessment.
Bronchoscopy, stenting and debulking for a narrowed or obstructed airway.
Fluid Around the LungsDraining and preventing recurrent pleural fluid, including with an indwelling catheter at home.
Emphysema TreatmentEndobronchial valves and lung volume reduction for breathlessness in severe emphysema.
Fitness for Lung SurgeryHow fitness and reserve are assessed when a major operation is being considered.
Lung Cancer Surgery in the ElderlyWhy fitness and frailty, not age, decide who can have surgery.
Specialist Second OpinionAn independent view on whether a symptom can be eased — within 2–3 days.
Lung Infection SurgerySurgery for localised bronchiectasis, aspergilloma, lung abscess, TB and hydatid disease, by specialist referral.